Wound splints

ABSTRACT

Bars or bar-like materials of slightly pliable elastomeric plastics are provided for use in post-surgical procedures in connection with sutures for closing incisions. The bars may be of various cross-sectional configurations, such as a flat or semicircular bar, with a downwardly converging slot or groove for the reception, guiding and gripping of the sutures.

United States Patent Leveen 1 May 27, 1975 [54] WOUND SPLINTS 3,541,591 l1/1970 I-Ioegerman 128/335 [76] Inventor: Harry H. Leveen, 800 Polly P1.,

Brooklyn, N.Y. 1 1209 FOREIGN PATENTS OR APPLICATIONS Dec. [21] Appl. No: 425,536

Related US Application Data Primary Examiner-Dalt0n L. Truluck [63] Continuation-impart of Ser. No. 158,687, July 1, 1971, Pat. No. 3,789,851, which is a continuation-in-part of Ser. No, 813,478, April 4, 1969, abandoned. [57] ABSTRACT [52] US. Cl. 128/335; 24/130; 24/264 Bars or bar-like materials of slightly pliable elasto- [51] Int. Cl A6lb 17/04 meric plastics are provided for use in post-surgical [58] Field of Search 128/334 R, 335, 335.5, procedures in connection with sutures for closing inci- 128/327; 24/129 B, 130, 264; 174/168, 175, sions. The bars may be of various cross-sectional con- 174; 206/633 figurations, such as a flat or semi-circular bar, with a downwardly converging slot or groove for the recep- [56] References Cited tion, guiding and gripping of the sutures.

6 Claims, 5 Drawing Figures 1 WOUND SPLINTS This application is a continuation-in-part of copend ing application Ser. No. 158,687, filed July 1, 1971, now US. Pat. No. 3,789,851, granted Feb. 5, 1974. which in turn is a continuation in-part of application Ser. No. 813,478, filed Apr. 4, 1969, now abandoned.

In the performance of abdominal surgery, retention sutures are assuming increased importance because of the demonstration that wound disruption is less frequent with mass wound closure than it is with approximation of the facial edges as in a layer to layer closure. (McCallum, G. T., Link, R. F. The Effect of Closure Technique on Abdominal Disruption. Surg. Gyn. & Obst. l 19:74, 1964). When retention sutures are used alone,'as indicated as aforementioned by McCallum et al., or combined with layer by layer closure, as advocated by Lehman et al. (Lehman, .I. A., Cross, F. S. and Partington, P. F., Prevention of Abdominal Wound Disruption. Surg. Gyn. & Obst. 126:1235, 1968), the danger of wound disruption is almost eliminated. Yet, mass closure of abdominal wounds has not received popular acceptance. The chief disadvantage to retention sutures and mass abdominal closure is the inclusion of a large volume of tissue in the ligature loop. Such tissue is compressed and devitalized when the tension is applied to close the wound; and, even when minimal tension is applied, the wound swells and the sutures cut the tissues. Hoerr (Hoerr, S. O. A New Single Layer Technique for Closing the Disrupted Wound. Surg. Gyn. & Obst. 126:] 19, 1968) maintains that the suture should ideally elongate with the swelling of the wound but such an ideal suture is not available. It is evident that two factors should be avoided, compression of tissue and resiliency in the loop which allows for maintenance of constant tension.

Various types of splints or bridges have been proposed to reduce this tissue compression. The most commonly employed device is to place the ligature through a circular tube of rubber which lies on the skin and serves as a stiffener to prevent some of the compression of the skin and cutting where the suture enters the tissue. Rubber tubes have the disadvantage in that they are not stiff enough and fall off the end of the suture and a hemostatic forceps or other device must be applied to the end of the suture to prevent this. Also, tubes are difficult to thread. Since it is the usual practice to place all the sutures before tying them, it is apparent that this extra procedure of placing clamps on the end of the sutures is time-consuming and cumbersome. The great disadvantage from this type of rubber tube lies in the fact that it is too flexible and does not avoid compression of the tissue. (Taylor, F. W., Jontz, .I. G., FIG. S-type Retention Sutures. Surg. Gyn. & Obst. 109:378, 1959).

The ideal situation as has been pointed out by Price (Price, P. 8., Stress, Strain and Sutures. Ann.Surg. 1281408, 1948) is to pull the divided abdominal wall toward the midline by sutures placed at either end of a rigid bar, the bar serving to absorb the compressive forces. Dennis (Dennis, C., Nelson, C. A., Anker, F. 1., Utilization of Wound Splints and Through and Through FIG. 8 Sutures of Stainless Steel Wire for Abdominal Closure in the Presence of Poor Wound Expectancy. Surg. Forum 41601, Oct. 1953) has advocated a figure of 8-closure utilizing a rigid straight bar over which the suture is tied. This bar takes up the compressing force rather than have the forces applied to the tissues. This 7 bar is a loose piece of apparatus which must be held under the suture during tying. It has the disadvantage in that the suture does not grip the bar tightly and that, as a rigid bar, predetermined sizes must be made and the bar cannot be easily shortened at the time of surgery. It has an added disadvantage since a rigid bar cannot exert constant tension on the suture but utilizes the elasticity of the tissue for this purpose which, of course, implies that the tissue must be compressed.

McCarthy (McCarthy, H. F., Tension (Stay) Suture Bridge, J. Int. Col. Surg. 34:613, 1960) has advised the use of a bar with a central elevation which holds the suture off the wound. This product has been used in three different sizes. It has the disadvantage of being cumbersome, is not attached to the suture, and the fixed sizes are not always adaptable to the patients needs. As described in US. Pat. No. 3,014,483, it does not maintain constant tension on the suture.

The present invention provides a wound splint in the form of a semi-rigid flat resilient bar of a slightly pliable elastomeric plastic material which allows the bar to take up a certain amount of increased tension by shortening and distorting. The bar is provided with a suture receiving groove extending lengthwise of the bar, the sides of which groove gradually converge downwardly from the surface. The groove is sized such that when a suture is placed in the groove the suture displaces the sides of the groove which frictionally engage the suture and hold it under tension. When the suture is tied across a wound the bar takes up compression and the suture gradually sinks in the groove.

The invention is illustrated in the accompanying drawing wherein:

FIG. 1 is a perspective view of a bar with a downwardly converging suture-receiving and gripping groove;

FIG. 2 is an enlarged cross-section taken at line 2-2 in FIG. 1 illustrating the retention of a suture in the converging groove;

FIG. 3 is a view similar to FIG. 2 illustrating the retention of a knot in the converging groove;

FIG. 4 is a modified form of a semi-circular bar wherein the suture-receiving groove is in the convex top of the bar; and

FIG. 5 is a fragmentary diagrammatic view of a surgical incision partly sutured and partly in the process of being sutured.

The simplest and preferred form of the device of this invention is shown in FIG. 1 in the shape of a flat bar 10 of greater width than height with a central groove 11 converging downwardly from the surface so that the suture 19 displaces the sides of the elastomeric material, as seen in FIG. 2, firmly to hold suture 19 so that the suture can be packaged with retention suture 19 attached to the bar and the bar can be inserted without the danger of retention suture bar 10 dropping off during the act of suture placement. Groove 11 holds suture l9 firmly but the frictional forces can be overcome and it is relatively easy to slide the bar along the long axis of the suture for proper placement and tying.

When suture 19 is employed to close a wound, for example employing a FIG. 8 suture configuration, bar 10 is slipped along suture 19 to overlie the wound. If necessary, bar 10 is first reduced in length by trimming with a scissor or knife, temporarily removing suture 19 from groove 11 during trimming. As the suture is placed under tension the compressive force is placed over the wound by bar and suture l9 gradually sinks in groove 11 to hold bar 10 in place, and the first throw of the knot is then received in groove 11, as shown in FIG. 3.

The invention is further illustrated in FIG. 4 which shows a form of the invention in which groove 12 of the same shape as groove 11 is illustrated as extending down from the convex upper surface 15 of a half cylinder bar 16 as well as from the upper surface of flat bar 10 as described above with respect to FIG. 1. It is evident that the actual shape or configuration of the extrusion need not be a half cylinder or a flat bar but can also be a trapezoid or other desired geometric configuration which provides a suitable cross-sectional area.

FIG. 5 shows a wound or incision 17 closed with a number of already placed sutures 19 in bars 10 and a suture 19 in the act of being placed and to which a bar 10 is attached. The bar grips the suture and does not fall off.

I claim:

1. A wound splint in the form of a semi-rigid flat resilient bar of pliable elastomeric plastic material, means defining a suture receiving groove extending lengthwise of said bar, said means including sides of said groove gradually converged downwardly from the surface of said bar, said sides being displaceable, whereby a suture placed in said groove displaces said sides frictionally to engage said sides.

2. A wound splint according to claim 1 in which said bar has a rectangular cross-section and said groove extends centrally in and along one surface of said bar.

3. A wound splint according to claim 1 in which said bar is a semi-cylinder and said groove extends centrally in and along the cylindrical surface of said bar.

4. In combination a wound splint in the form of a semi-rigid flat resilient bar of pliable elastomeric material, means defining a suture receiving groove extend-v ing lengthwise of said bar, said means including sides of said groove gradually converged downwardly from the surface of said bar, and a suture placed in said groove displacing said sides whereby said sides frictionally engage said suture.

5. The combination of claim 4 in which said bar has a rectangular cross-section and said groove extends centrally in and along one surface of said bar.

6. The combination of claim 4 in which said bar is a semi-cylinder and said groove extends centrally in and along the cylindrical surface of said bar. 

1. A wound splint in the form of a semi-rigid flat resilient bar of pliable elastomeric plastic material, means defining a suture receiving groove extending lengthwise of said bar, said means including sides of said groove gradually converged downwardly from the surface of said bar, said sides being displaceable, whereby a suture placed in said groove displaces said sides frictionally to engage said sides.
 2. A wound splint according to claim 1 in which said bar has a rectangular cross-section and said groove extends centrally in and along one surface of said bar.
 3. A wound splint according to claim 1 in which said bar is a semi-cylinder and said groove extends centrally in and along the cylindrical surface of said bar.
 4. In combination a wound splint in the form of a semi-rigid flat resilient bar of pliable elastomeric material, means defining a suture receiving groove extending lengthwise of said bar, said means including sides of said groove gradually converged downwardly from the surface of said bar, and a suture placed in said groove displacing said sides whereby said sides frictionally engage said suture.
 5. The combination of claim 4 in which said bar has a rectangular cross-section and said groove extends centrally in and along one surface of said bar.
 6. The combination of claim 4 in which said bar is a semi-cylinder and said groove extends centrally in and along the cylindrical surface of said bar. 